2019 Consumer Satisfaction with the Aging & …...the needs they identified as reasons why they contacted the ADRC. This is the sixth consumer satisfaction survey conducted by Portland

Consumer Satisfaction with the Aging & Disability

Resource Connection of Oregon: Round 6

Part 1: 2019 Survey Participants Submitted to

Oregon State Unit on Aging, Department of Human Services

Diana L. White, PhD Allyson Stodola, MSW

Final Report 2019

1 ADRC of Oregon www.ADRCofOregon.org 1-855-ORE-ADRC PSU Institute on Aging Diana White, PhD, [email protected] 503 725-2725

Consumer Satisfaction with Aging & Disability Resource Connection (ADRC) Services: Round 6

Diana White and Allyson Stodola Portland State University Institute on Aging

June 2019

Part 1. Introduction and 2019 Survey Participants

This first section of the 2019 (Round 6) ADRC consumer satisfaction report

describes revisions to the ADRC Consumer Satisfaction survey, the methods used

to conduct the evaluation, the sample characteristics of those interviewed, and

the needs they identified as reasons why they contacted the ADRC. This is the

sixth consumer satisfaction survey conducted by Portland State University (PSU)

and follows the Round 5 survey conducted in 2015. The survey instrument can be

found in Appendix A. The tables referred to in this report are presented at the

end of this section, and in Appendix B. Many tables include comparisons of

findings across the six rounds of data collection as well as tables featuring findings

from new questions added to the Round 6 survey. This project was approved by

the PSU Institutional Review Board.

Measures Several new questions were added to the survey in 2019 (See Table 1.1 on

the following page). These changes were made in response to recommendations

from the consultants from Compelling Reason who had been hired to develop a

business case for the ADRC and calculate the return on investment. In addition,

new questions addressed ADRC services that had not been covered adequately in

prior surveys (e.g., specific information about health promotion activities and

services). New items were discussed by PSU project staff, representatives from

http://www.adrcoforegon.org/

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Compelling Reason,

Community Services and

Support staff, and Business

Case Steering Committee.

In addition, we quantified

a question that had been

asked previously only as an

open-ended question:

What would your

circumstances be without

the ADRC? The major

themes were listed based

on data from prior years

and each person was

asked to indicate their

agreement with the

statements (yes/no).

Other items were

eliminated so as not to add

burden to the participants.

Previous surveys averaged

about 20 minutes and we

wanted to keep the length

of the survey within this

range. The group jointly

agreed on questions to

eliminate, including how

participants learned about

the ADRC, whether they used the website, and whether they visited the ADRC

Table 1.1. Changes to the Survey in Round 6

New Questions

Reasons for contacting the ADRC. Worries about:

o Getting medical equipment or assistive devices

o Eviction or homelessness

o Falling

o Abuse or neglect (including specific types of abuse)

Services received to address:

o Abuse or neglect

o Housing to prevent eviction or homelessness

o Fall prevention classes (with specific types of classes

listed)

Outcomes—As a result of the ADRC: o I am less likely to fall

o I am less likely to move into a nursing home

o I am at less risk of abuse or neglect

Question with a New Format: Circumstances without the ADRC

I would not have the information I need to get help

I would be stressed about not knowing what to do

I would not have had the help I need

I could not meet my basic needs

I would be more isolated from the community

My medical condition would be worse

I would be in a nursing home

I would be dead

I would be worse off financially

I would be homeless

It would be no different

I would be better off


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building. In spite of these changes to the survey, most of the Round 6 survey

questions remained the same as those in previous years.

Sample Selection As in previous surveys, two groups were targeted: those only using ADRC

Call Center services and recipients of Options Counseling (OC) services. The Call

Center sample was selected from a random sample of ADRC Call Center

consumers stratified by region and consumers from all Centers for Independent

Living (CIL). The consumers sampled had been in contact with the ADRC Call

Center from January 25 – February 8, 2019 (n=2,468). At the time the sample was

drawn, none of these individuals had received Options Counseling services. The

two-week window was used so that participants would be interviewed within one

month of their contact with the ADRC. This decision was made after earlier survey

rounds when it became apparent that many Call Center participants had difficulty

recalling their specific ADRC experiences after one month.

The OC sample consisted of everyone who had used Options Counseling

services between December 26, 2018 and March 12, 2019 (N=475). This longer

time frame was used for OC consumer interviews because fewer consumers

receive OC services and the largest sample possible was needed to reach the goal

of 135 completed interviews. In addition, fewer consumers were in the OC sample

received than in the past. For comparison, the total OC sample received in 2015

was 636. Furthermore, because OC consumers generally have more frequent or

intensive contact with the ADRC than Call Center consumers, more confidence

can be placed in OC consumer survey responses over the two and a half-month

window.

The sampling frame is presented in Table 1.21. The goal for Call Center

consumers was 190 completed interviews stratified to represent the ADRCs and

1 Tables 1.2 – 1.8 are at the end of this report; all tables are presented in Appendix B


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CILs across the state; all CILs in Oregon were included. Targets were not reached

for CILs; only three names were received and none could be interviewed. In

addition, targets of 13 completed interviews were not met in four ADRCs (Central

Oregon, Douglas County, South Coast, or Eastern Oregon). However, the overall

sampling goal was met by oversampling for Lane, NW Senior & Disabled Services,

and the Metro ADRCs. The Metro ADRC sample was significantly larger than in

previous years. As a result, only a segment of those interviews are included in this

report to make results more comparable to previous rounds. The Metro sample

included in this report was selected randomly from all the completed interviews.

The goal for the OC consumer sample of 135 was not met. The target

number reflected the number of OC consumers interviewed in 2015, but only 80

interviews were completed in this round. This is a result of the smaller sample

received from the ADRC program (see Table 1.2). One reason for the smaller

sample is that only those who were enrolled and had been in contact with the

Options Counselor were included in the sample. In previous years, all of those

actively enrolled were included, regardless of whether or not they had been in

contact with the Options Counselor.

Interview procedures

Telephone interviews were conducted by the Social & Economic Sciences

Research Center at Washington State University. Interviews were conducted

between February 27 and April 5, 2019. Interviews averaged about 26½ minutes,

more than five minutes longer than previous surveys, reflecting the addition of

the new questions. Of the 2,867 unduplicated numbers received from the ADRC

program, 1,104 were deemed to be appropriate numbers (38%). This means that

when the number was called, a contact was made. Interviews either were

completed, partially completed or an interview was not conducted. The

completion or partial completion rate was 36%. Reasons for not conducting the

interview were due to refusal (n=314; 28% of appropriate numbers), contact with


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the ADRC-named person was not made (n=196), the person was not available for

the interview (n=7), the person had died (n=22), they were physically or

cognitively unable to participate in an interview (n=23), or there was a language

problem (n=40)2.

It is unknown whether some numbers were connected to the ADRC

consumers because in spite of multiple calls, no contact was made (n=1100; 38%).

This included phones with answering machines only (n=836), no answer (n=105),

call blocking (91), or regularly busy (n=63).

Other numbers were inappropriate numbers (24%); that is, the numbers

were not connected to an ADRC consumer. The largest categories for ineligible

numbers were no eligible respondent in the household (n=275), nonworking

numbers (n=111); numbers had changed (n=90), and disconnected numbers

(n=77).

The final options counseling sample was 80 completed and 13 partially

completed interviews. After adjusting for the oversampling of the Metro ADRC,

the final Call Center sample described in this report is 239 completed interviews

and 34 uncompleted interviews. Each table contains the number of participants

who answered the specific questions addressed in the table.

Sample Characteristics

Of the 367 participants in this sample, 250 (78%) were consumers of

services, defined here as the direct recipient of services. This is a similar

percentage reported in previous years. The remaining 22% was made up of 69

family members (Table 1.3).

2 The languages of those not interviewed were Spanish (14), Chinese (7), Asian not specified (5), Russian (2), Japanese (1), Somalian (1), unknown/unspecified (8).


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Sample characteristics are consistent with those found in previous surveys.

The majority of participants were women, although by lower percentages than in

previous years (61% of consumers, 64% of family members); this is consistent

with the trend for reaching more men noted in 2015. Two people, one consumer

and one family member, identified themselves as gender neutral. The average age

of consumers was 69 years of age compared to 64 years for family; each group

was slightly older than consumers and family members in 2015. Consumer ages

ranged from 27 to 95 years, with a similar age span for family (27-94 years). The

median education level for consumers was “some college” and the median

education level for family was an associate’s degree. The median income for

consumers was the $10,000-20,000, which has been the same in all rounds of the

survey. The median family income was in the $20,000-30,000 range, considerably

lower than in 2015. The sample continues to be dominated by Whites; 85% of

consumers and 84% of family members. When asked whether they had concerns

with memory loss, 28% of consumers and 62% of family members answered

affirmatively (Table 1.3), which are larger percentages than all previous years this

question has been asked.

Of those receiving OC services, 66% received a home visit (17% of the entire

sample). Nearly one third of Call Center consumers (31%) also reported a home

visit (23% of the overall sample). All OC consumers and family members

(regardless of whether or not they received a home visit) and Call Center

consumers who reported a home visit (n=167) were administered a long version

of the survey which included questions about home visits, decision support and

perceived outcomes related to their involvement with the ADRC (Table 1.4).

Needs

Participants were asked to describe why they had come into contact with

the ADRC. The interviewer then read a list of 20 possible reasons, including the

four new items about concerns with housing, falls, abuse or neglect, or help with


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medical equipment and they were asked if any of these had been a reason why

they contacted the ADRC.

Patterns of need were similar to or higher than those found in previous

rounds (Table 1.5). In 2019, higher percentages of participants indicated needs

related to energy bills, help with medications, and physical health needs. With

respect to the new items, 128 participants (40%) indicated concerns about falls,

102 (28%) needed assistance with getting new medical equipment or assistive

devices, 70 (20%) had concerns about eviction from housing or homelessness, and

35 (10%) had concerns about abuse or neglect. As shown in Table 1.5, the primary

abuse concern was emotional abuse (88%), followed by neglect (69%), financial

exploitation (57%), abandonment (47%), physical abuse (40%), and sexual abuse

(22%).

The 20 people who reported worries about financial exploitation were

asked how much money was at risk. Of the 16 people who responded, only a few

provided specific dollar amounts, which ranged from $200 – $6,000. Others

indicated it was “a lot of money,” or “large amounts.” Others said someone got

“whatever they could get,” “a monthly social security benefit,” “my mother’s

home,” and others were not sure. One person indicated her caregivers were

stealing from her.

As in previous surveys, many participants had multiple needs. About two-

thirds of participants contacted the ADRC to obtain information or advice. Well

over two-thirds participants (71%) indicated they or a family member had physical

health needs that resulted in a need for services. Need for help at home with

tasks such as making meals, housekeeping, laundry or yard work were each

identified by 44% of participants and the same percentage indicated a need for

personal care. The need for Medicaid assistance was reported by 40%, followed

by transportation (38%), medications (36%), and help getting errands and

shopping done (36%). Close to 30% of participants indicated needs related to


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food stamps (28%) and confusion or memory loss (28%), Some reported needs

related to paying energy bills (26%), help finding subsidized housing (20%), home

modification (19%), dental care (18%), moving into residential care (15%), or

“other” needs (18%). When asked what other needs they had, most of those

identified fit into the categories described above.

A greater percentage of family members (81% compared to 61% of

consumers), contacted the ADRC to get information or advice. In addition, family

members were significantly more likely to report physical health needs, needs for

personal care, getting assistance for caregivers, and moving a person into a

residential care setting. Family members were also significantly more likely to

report that the care recipient was experiencing confusion and memory loss. As in

previous years, family members, therefore, were contacting the ADRC on behalf

of a consumer who required assistance with activities of daily living (ADL),

instrumental activities of daily living (IADL), and a variety of health care issues. As

before, consumers were more likely to be calling about food stamps or getting

assistance with energy bills.

Differences between needs identified by Options Counseling and Call

Center consumers were identified. Options counseling consumers were

significantly more likely than other consumers to report physical health needs,

needs for personal care, and help getting shopping and errands done. Call Center

consumers were significantly more likely to report needs with respect to Medicaid

or paying for medical care, food stamps, and concerns with eviction or

homelessness.

The number of needs was summed for each participant. Of a possible 20,

the number of needs reported ranged from 0 to 20. Families reported more

needs, but differences were not statistically significant. To compare needs to

previous years, the original 16 areas of need were summed. In 2019, the average


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number of needs reported was 5.4, somewhat higher than the 4.9 needs reported

in 2015.

To identify possible cognitive impairment, participants were asked: During

the past 12 months, have you experienced confusion or memory loss that is

happening more or is getting worse? Percentages of those responding

affirmatively are similar to previous years, although slightly lower (Table 1.6); 28%

of consumers and 62% of family. As before, families were significantly more likely

than consumers to report confusion and memory loss. Of those indicating these

cognitive challenges, only 4 consumers (6%) and 19 (45%) reported the consumer

had received a diagnosis of Alzheimer’s disease (Table 1.7). The following

comments reflect participants’ concerns, needs, and reasons for calling the ADRC

in 2019.

To look into respite care and what kind of assistance is available for my mother. I was having some issues finding housing. That's basically what I was looking for and they've been doing a good job looking for housing resources. They've done their best so far. I'm getting concerned about my ability to continue limping alone. I'm losing balance I'm making mistakes like leaving the burner on and I flooded the bathroom. I'm concerned about myself and my abilities so I wanted to start looking at the option of me not living alone. I needed help with energy assistance because they turned my lights off. I needed some new dentures and I don't make enough to afford them. Homeless, 77 years old, a kidney failure. My husband has PTSD so we were looking for assistance because we were getting overwhelmed. I was trying to take care of him and a disabled child. I was trying to see if I could get help paying bills and if so, who could help me with that. I am 74 years old, at the time I was falling down and I wasn't able to clean house. I had a cognitive test performed by my doctor, which showed some possible early dementia symptoms, I also get short of breath and they think that might be causing me some confusion from lack of oxygen. So I wanted to see what services that the ADRC has available if I need something in the near future. I need to get my brother in memory care and I can’t financially do it myself. My brother has Alzheimer's.


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Conclusions

The 2019 sample is less representative of the state of Oregon than in 2015,

with more regions of the state having few participants in the sample. Fewer

options counseling consumers were recruited for this survey reflecting the smaller

sample available from the ADRC program.

It is useful to compare family and consumer responses. As in past years,

family members are calling the ADRC requesting support for their care recipients

who have significant disabilities, including cognitive decline. They are arranging

for services to support ADL and IADL needs, to find the most appropriate levels of

care, and to find the resources to pay for those services. Although they are

experiencing disability and the need for ADL and IADL services, consumers are

more likely than family members to be looking for financial assistance in the form

of food stamps and energy assistance, a consistent pattern over time.

Questions added to the survey in 2019 reveal a sizeable number of

participants who have worries about falling and need assistance obtaining

medical equipment and assistive devices. One in five participants reported

concerns about eviction or becoming homeless, reflecting the growing housing

crisis for older adults. Not surprisingly, there is significant overlap with consumers

who were seeking help finding subsidized housing and concerns with eviction or

homelessness. Finally, concerns with abuse or neglect reflect some national

estimates of abuse experienced by community dwelling elders.3

3 Teaster, P. B., Wangmo, T., & Vorsky, F. B. (2012). Elder abuse in aging families. In R. Bliezner & V. H. Bedford (Eds.) Handbook of Families and Aging (second edition). pp. (409-429). Praeger: Santa Barbara, CA.


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Table 1.2 2019 Sampling Frame

Sample Received

Sample Goal

Actual Completesa

ADRC Call Center

Lane COG 298 19 30

NW Senior & Disability Services 626 24 67 Oregon Cascades West COG 344 24 26

Metro (Multnomah, Clackamas, Columbia, Washington)

1000 42 84b

Central (Central Oregon Council on Aging) 11 13 1 South Coast 78 13 10

Rogue Valley COG 17 14 15 Douglas (DCSDS) 29 13 4

Eastern Oregon (CCNO) 62 13 2

Centers for Independent Living 3 15 0 Subtotal 2,468 190 239

Options Counseling

Lane COG 53 13 13 NW Senior & Disability Services 30 13 4

Oregon Cascades West COG 106 13 13


200 37 37

Central (Central Oregon Council on Aging) 6 9 0 Rogue Valley COG 23 9 4

Douglas (DCSDS) 5 9 0 Eastern Oregon (CCNO) 26 9 5

South Coast 2 9 1 Centers for Independent Living 24 15 4

Subtotal 475 136 80

Total 2,943 326 319 aAn additional 47 interviews were partially complete and are used in analyses throughout the report when data are available for the specific question b119 Although oversampling has occurred in every year in the Metro area to achieve our sampling goals, the Call Center interviews completed in 2019 were nearly 3 times the goal for the Metro area. To keep the distribution comparable to other years, 84 completed interviews are included in this report.


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Table 1.3 Round 6 Sample Distribution by respondent type

ADRC Option Counseling (n=81)

Call Center (N=238)

Total subgroup Total

Consumer Family Consumer Family Consumer Family Lane COG 11 2 21 9 32 11 43

NW Senior & Disability Services

1 3 49 17 50 20 70

Oregon Cascades West COG

8 5 21 5 29 10 39


32 5 78 8 108 13 121

Central (Central Oregon Council on Aging)

1 0 1 0 1

Rogue Valley COG 2 2 11 4 13 6 19

Douglas (DCSDS) 2 2 2 2 4

Eastern Oregon (CCNO)

2 3 1 1 3 4 7

South Coast 1 0 7 3 8 3 11 Centers for Independent Living

4 0 0 0 4 0 4

TOTAL 61 20 189 49 250 69 319


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Table 1.4 Sample Characteristics

Participants Total Sample (N=319)

Consumer Family

# % # %

Number 249 78% 68 21%

Gender Neutral 1 .3% 1 1.5%

Women 153 61% 50 74%

Age Average: 69 years Median: 69 years

Average: 64 years Median: 65 years

Age Range 27 - 95 years 27 – 94 years

Median Education Some college Associates

degree

Median Income $10,000 to <

$20,000 48%

$20,000 to < $30,000

16%

Number/Percent White

212 85% 58 84%

Concern about memory

loss/confusion last 12 months

68 28% 43 62%

Table 1.5 Sample by Options Counseling and Home Visit Categories

2012 2013 2014 2015 2019

N=297 % N=292 % N=300 % N=326 % N=343 %

Options Counseling, home

visit 57 19% 73 25% 82 27% 87 27% 59 17%

Options Counseling, no

home visit 14 5% 27 9% 19 6% 50 15% 30 9%

Call Center consumer,

home visit 64 22% 45 15% 76 25% 56 17% 78 23%

Call Center consumer, no

home visit 162 55% 147 50% 123 41% 133 41% 176 51%

Note: Not all percentages add to 100 due to rounding


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Table 1.6 Reasons for Contacting the ADRC

Service Type 2012 N (%)

2013 N (%)

2014 N (%)

2015 N (%)

2019 N (%)

Physical health needsa,c 161 (54%)

177 (60%)

188 (61%)

202 (62%)

258 (71%)

General information/advicec 222 (73%)

212 (71%)

215 (70%)

222 (68%)

227 (64%)

Help at home (making meals, housekeeping, laundry, yard work)a

113 (37%)

103 (35%)

147 (48%)

143 (44%)

159 (44%)

Personal Carea,c 87 (29%)

95 (32%)

126 (41%)

117 (36%)

156 (44%)

Medicaid or paying for medical careb 104 (35%)

100 (34%)

118 (39%)

122 (37%)

143 (40%)

Falls - - - - 128

(40%)

Transportationa 99

(33%) 92

(31%) 114

(37%) 116

(36%) 139

(38%)

Help getting shopping and errands donea 53

(18%) 68

(23%) 108

(35%) 98

(30%) 128

(36%)

Medications 78

(26%) 73

(25%) 80

(26%) 73

(23%) 132

(36%)

Food stampsb,d 105

(35%) 80

(27%)

90

(30%)

95 (29%)

105

(29%)

Confusion or memory lossa,c 74

(25%) 71

(24%) 69

(23%) 84

(26%) 102

(28%)

Help getting new medical equipment or assisted devices

- - - - 102

(28%)

Energy Billsd 64

(21%) 47

(16%) 58

(19%) 60

(18%) 93

(26%)

Help getting caregiver support or respitec 62

(21%) 70

(24%) 52

(17%) 61

(19%)

82

(23%)

Eviction from current home or homelessness d - - - - 70

(20%)


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Service Type 2012 N (%)

2013 N (%)

2014 N (%)

2015 N (%)

2019 N (%)

Help with housing: finding subsidized housingd

50 (16%)

57 (19%)

36 (19%)

58 (18%)

72 (20%)

Dental care 58

(19%) 31

(10%) 53

(17%) 49

(15%) 66

(18%)

Help with housing: home modification 50

(17%) 41

(14%) 39

(14%) 45

(14%) 69

(19%)

Help moving into residential carec 36 (12%)

42 (14%)

33 (14%)

47 (14%)

53 (15%)

Abuse or neglect - - - - 35

(10%)

Did you contact ADRC to get help with anything else that we did not already cover?

57 (19%)

43 (15%)

37 (12%)

57 (17%)

60 (18%)

aOptions counseling consumers significantly more likely than call center consumers to report this need

(p<.05) bCall center consumers significantly more likely than options counseling consumers to report this need

(p<.05) cfamily members significantly more likely than consumers to report this need (p<.05) dconsumers significantly more likely than family members to report this need (p<.05)

Table 1.7 Areas of abuse or neglect that are of concern

Type 2019 N (%)

Physical abuse 14 (40%)

Emotional abuse 30 (88%)

Financial exploitation* 20 (57%)

Sexual abuse 7 (22%)

Neglect 22 (69%)

Abandonment 15 (47%)


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Table 1.8. During the past 12 months have you experienced confusion or memory loss?

Consumer Family/Friends Total

2013

(n=69) 2014

(n=218)

2015 (n=231)

2019 (n=244)

2013 (n=25)

2014 (n=80)

2015 (n=85)

2019 (n=69)

2013 (n=94)

2014 (n=298)

2015 (n=316)

2019 (n=313)

Yes 20

(29%) 64

(29%) 69

(30%) 68

(28%) 12

(48%) 45

(56%) 54

(64%) 43

(62%) 32

(34%) 109

(37%) 123

(39%) 111

(36%)

Note: In 2013 only OC consumers and family were asked this question; in subsequent years all have been asked this question. In all years, family members were significantly more likely to report confusion or memory loss than consumers.

Table 1.9 Have you received a diagnosis of Alzheimer’s disease?

Consumer Family/Friends Total

2014

(n=64 ) 2015

(n=66 ) 2019

(n=67) 2014

(n=44 ) 2015

(n=53) 2019

(n=42) 2014

(n=108) 2015

(n=119) 2019

(n=109)

Yes 8

(12%) 9

(14%) 4 (6%)

18 (41%)

26 (49%)

19 (45%)

26 (23%)

35 (29%)

23 (21%)

Note: in all years, family/neighbors were significantly more likely to report a diagnosis of Alzheimer’s disease than consumers.


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Documents

2019 Consumer Satisfaction with the Aging & …...the needs they identified as reasons why they contacted the ADRC. This is the sixth consumer satisfaction survey conducted by Portland